AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation

Background: The performance of AlloDerm (LifeCell Corp., Branchburg, N.J.) in the setting of prosthetic breast reconstruction, infection, and radiation therapy has not been well documented. The purpose of this study was to review the author's experience with AlloDerm-assisted prosthetic breast surgery and determine the tolerance in the setting of infection and irradiation. Methods: A total of 361 women and 476 breasts underwent reconstruction or revision with prosthetic devices. Of these, 76 women and 100 breasts underwent reconstruction using AlloDerm assistance. Results: The incidence of postoperative infection was 5.85 percent (22 of 376) when prosthetic devices were used without AlloDerm and 5 percent (five of 100) when prosthetic devices were used with AlloDerm. Radiation therapy was a factor in 23 of 100 breasts reconstructed with AlloDerm. Adherence of AlloDerm was noted in 100 percent (23 of 23) and infection was noted in 8.7 percent (two of 23). The timing of irradiation (before or after AlloDerm insertion) did not affect the adherence or the infection rate. The overall incidence of seroma was 5 percent, the incidence of skin necrosis was 3 percent, and the incidence of incisional dehiscence was 4 percent. Conclusions: This study demonstrates that prosthetic breast surgery using AlloDerm is safe and well-tolerated. AlloDerm viability has been demonstrated in the setting of infection and radiation therapy. The risk of prosthetic breast infection in the setting with AlloDerm is no different from in the setting without AlloDerm. Local complications such as dehiscence, skin necrosis, and seroma formation can occur in accordance with radiotherapy.